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Stale of CcJifornio—Environmental Protection Agency <br /> Fcnn Approved OMB No.2050-0039(Expires 930.991 `` JJ See Instructions on back o' /, 6. Department of Toxic Substances Conn <br /> Please print or type. Form designed for use on elite(12Pack) � <br /> „ .x1118.. •�y�s. q Sacmmemo,California <br /> I. <br /> Generator's US EPA ID No. Manifest Document No. 2. Page I Information in the shaded areas <br /> UNIFORM HAZARDOUS s nod 11 6,Federal law <br /> WASTE MANIFEST of <br /> 3. Generator's Name and Moiling Address.9,FG0 PO,p4c%rS Co.1P9�y T6diSIahs gAu <br /> Jc 6.55 %�4 a s ale Ga teralo/37LT <br /> M C)R o 6A GA e— 3 a <br /> h 'a. Generator's Phone 9zs P <br /> N 5 Transporter I Company Name 6. US EPA ID Number Cela 5� - �t•.i}�' C .: <br /> f5 Tfa"a� edS <br /> o ECOLOGY CONTROL INDUSTRIES 9`. � ?•' a <br /> OP 7 Transporter 2 Company Name 8. US EPA ID Number E vihif. �s Ich > 'x q <br /> V 9. Designated Facility Nanta and Sne Address 10. US EPA ID Number <br /> rr y, <br /> a ERICKSON INC. - <br /> 3Z ct s Phan° <br /> 255 PARR BLVD <br /> �ORICHMOND. CA 94804 12 IAb— 0-10-19 616-11 1- <br /> xx� � <br /> .0 Iotie <br /> 1IUSDOTD....i fonlincludin ProPerShiPPmgName,HazardClass,and DNumber1 Is 13Total IA, Unit <br /> No. Type Quantity Wh/Vol i aefnjNBm <br /> iZ <br /> =� WASTE EMPTY STORAGE TANK A ih5 C M <br /> E Non-RCRA hazardous waste solid © 0 P <br /> )o N Is. <br /> m E <br /> N R <br /> e A c. s <br /> o T £i . <br /> R <br /> z y: <br /> W d. <br /> Z <br /> z <br /> Tye <br /> w _ r <br /> Zniiaa sc� <br /> eby of IddaYs4iled.7k6o """�=': ""k-: - ' ,b.Tg'c`,_. 'Tp `'"•Ips. { <br /> O F•§ �} '"c 'v ...mss .•rs <br /> a =� _ Va <br /> .:t.�.: <br /> 0 15. Special Handling Instructions and Additional Information <br /> P= <br /> Wear appropriate protective clothing when handling. SITE LOCATION: <br /> Z 24 Hour Emergency Telephone Number: <br /> = 24 Hour Emergency Contact: ERG# 171 <br /> Id. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this constg m are fully and accurately described above by proper shipying name and are classified,packed, <br /> (al marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> J <br /> 111'.a 1... ...miq generator, I certify that I have pro?,..m in place to reduce the volume and toxicity of waste generated to the degree I have determined to be ecommicallyy <br /> v. practicable and that 1 have selected the predicable methodra <br /> al treatment,stoge ) <br /> ,or disposal currently available to me which minimizes the present and future threat to human heahh <br /> wend the environment;OR,if I ora a small quantity generator,I have made a good Faith effort to minimize my waste generation and select the best waste management method that is <br /> W available to me and that I can afford. <br /> 0 <br /> y Prinled/Typed Name (L Signature Month Day Year <br /> Z e `1} � 0711 D Z LS 6 <br /> tL T 17. Trons der I Acknowled a tint of R ei t of Materials <br /> w i Prints /Typed Name m Sig for y Month Day Year <br /> zS <br /> 00 18, Traas rter 2 Acknowledgement of Rectu t of Materials <br /> 1 Printed/Typed Name Sign urs Month Day Year <br /> W E <br /> Q R <br /> V 19 Discrepancy indication Space <br /> Z F <br /> — q <br /> C <br /> I <br /> L <br /> I 20 Facili Owner or Opsenoter Certification of receipt of hazardous materials covered by this mandev exce t as noted in Item 19. <br /> T Primed/T ped Nome Signature month Day Year <br /> y 10 15,47D Afw 51n L S q `� <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A lA/971 <br /> EPA 8700-22 - <br />